Obesity Surgery

, Volume 29, Issue 4, pp 1442–1444 | Cite as

Roux-en-Y Gastric Bypass Reversal for Severe Malnutrition and Cirrhosis

  • N. Beghdadi
  • A. Soprani
  • A. Kraemer
  • P. Bucur
  • C. Barrat
  • L. GenserEmail author
Video Submission



Severe post-operative malnutrition (SM) is a dreaded complication after gastric bypass often related to the short bowel syndrome consecutive limb length mismeasurement or intestinal resections. Patients with rapid weight loss or malnutrition can experience liver failure with cirrhosis and require liver transplantation (LT). Malnutrition can constitute a contraindication to LT since it negatively impacts on postoperative morbidity. RYGB reversal is an effective option to consider when nutritional support has failed. We describe the performance of a RYGB reversal in a pre-LT setting.

Material and Methods

A 36-year-old patient with morbid obesity (weight, 140 kg; BMI, 50.1 kg/m2) underwent a RYGB 9 years ago. She presented with 85 kg weight loss (i.e., 60.7% total body weight loss) associated with SM and hepatocellular insufficiency. LT was considered but contraindicated because of SM. An intensive nutritional support was attempted but failed and the RYGB reversal was recommended.


Laparoscopic exploration revealed ascites, cirrhosis, and splenomegaly. The whole small bowel measurement revealed a short gut. Alimentary, biliary, and common channel limb lengths were 250 cm, 150 cm, and 30 cm long. The alimentary limb was stapled off the gastric pouch and the gastrojejunostomy was resected. After resection of the gastrojejunostomy, linear stappled gastro-gastrostomy and jéjuno-jejunostomy were performed to restore the normal anatomy. At 1 year, malnutrition was resolved and the cirrhosis was stabilized.


Reversal to normal anatomy appeared effective and safe in this setting but must be considered only after failure of intensive medical management. Careful bowel measurement is mandatory to prevent patients from this complication.


Bypass Reversal Malnutrition Cirrhosis Liver 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

For this type of study, formal consent is not required.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

11695_2019_3770_MOESM1_ESM.mp4 (166.9 mb)
ESM 1 (MP4 170865 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Digestive SurgeryGénérale de Santé (GDS), Clinique Geoffroy-Saint HilaireParisFrance
  2. 2.Department of Digestive Surgery, Hepatobiliary Surgery and Liver TransplantationUniversity Hospital of ToursToursFrance
  3. 3.Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Digestive and Metabolic Surgery, Avicenne University Hospital, Centre intégré Nord Francilien de la prise en charge de l’Obésité (CINFO)Université Paris XIII-UFR SMBH « Léonard de Vinci »BobignyFrance

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